Tag Archives: eating disorders

How to prevent a binge.

When most people think about eating disorders the image of a low weight person who restricts their food intake comes to mind. Anorexia Nervosa is the most commonly talked about and known about eating disorder. However there are other kinds. I also work with people who suffer from Bulimia Nervosa, binge eating disorder and a mixture of all the above.

Whilst restricting your food intake can sometimes be understood as “dieting that has gone too far”, bingeing is less socially acceptable. In my mind both of these ways of eating are problematic and indicate underlying issues that need to be worked through. An eating disorder is a horrible illness that is hard to understand for those around the person, it can be consuming for the person and it takes a lot of willpower, guts and hard work to conquer it. I hugely admire the people I work with who make those steps towards beating this nasty mental illness.

A true binge involves eating a large amount of food in an uncontrolled manner. We are not just talking half a packet of biscuits. Some binges can range into several thousand calories. Some people describe a switch being flipped, they are unable to stop and are almost in  trance like state. After a binge you are likely to feel very uncomfortable physically due to the amount eaten and you may feel uncomfortable emotionally and psychologically. Many people have an urge to compensate – for example exercising, purging (vomiting) or restricting their food to make up for the binge.

 

The science

You cannot vomit up all the calories you have eaten. The maximum you get rid of is 60%. Absorption starts in the oesophagus so by the time food gets to your stomach you have already absorbed some.

Restricting after a binge leads you into a cycle. When you restrict you end up really hungry at some stage which then leads to another binge. 

You would need to do a lot of exercise to burn off all the calories from a binge. 

So the best answer is to try to prevent a binge from happening in the first place. Now this is easier said than done. It will take time and be a work in progress. My top tip is to not expect to just stop bingeing and to expect a relapse to happen. When it does, it is ok. Just get back on track as soon as you can.

 

Preventing a binge:

1. Identify the key times you binge. Think about the Why, Where, When and How it happens. 

Why – how do you feel before a binge? Bored, tired, upset, angry, hungry?

Where – is it linked to being on your own, in a certain place?

When – does a binge happen at a certain time of day?

How – how do you get the foods you binge on? 

2. Use the above information to think about how you could stop a binge occurring. Is there an activity/place you need to avoid? Can you limit access to the binge foods?

3. There should be a point just before a binge occurs when you are thinking about bingeing. The idea is in your head. This is the point to stop it. Jump in there and say NO. At this stage you need a distraction. So write out a list of things that could take you away from the binge, that keep your mind and hands busy. Good options can include doing something crafty, calling a friend on the phone, having a shower, journalling how you feel, having a bath.

4. Look at your meal plan – it need to be structured with regular meals and snacks to prevent you getting too hungry. It may be that building a snack in at a key time will help prevent a binge. 

If you do binge DO NOT PANIC. Get right back on track with your normal eating plan as soon as possible to stop that restriction, bingeing cycle. 

You can do it. I know it.

Boosting your nutritional intake – the healthy way to weight gain.

I work in the topsy turvy world that is eating disorders. Most of the media focus, food manufacturers, shops and nutrition business is on how to lose weight. whilst I work with people on how to gain or maintain their weight. Gaining weight may sound like it is easy to do but it often isn’t. You need to increase your dietary intake by 350-500kcals per day to start gaining weight. Now if you don’t have an eating disorder that may seem like no hard thing. A latte and slice of cake will easily hit the mark. However often the clients I work with are keen to increase the energy density of their diet in healthy ways. Now I’m all for eating plenty of veggies but you will have to eat a whopping amount if you are going to gain weight on extra veggies alone As I had to explain to one client recently – 350kcals extra in salad alone would mean you would be eating salad all day long. However there are options, if you can keep an open mind. 

Foods like nuts, seeds, avocado, dried fruit, nut butters, hummus, yoghurt, cheese, eggs, olive or rapeseed oils and fruit juices, will provide a nutrient dense way to increase the calories of your diet.

Dietitian UK: Why almonds are so good for you

 

Some of these foods may be on the scary side but they all provide nutrients that the body needs.

Dietitian UK: Gaining weight the healthy way for eating disorders

Here are some of my top suggestions of ways to boost up your intake by around 350kcals:
 
Add 1 tbsp seeds and 1 tbsp dried fruit to your normal cereal then top with your usual milk plus 2 tbsp yoghurt and add a glass of fruit juice.
Make your own snack boxes with nuts, dried fruit and small crackers (e.g: 15 almonds, 5 dried apricots, 7 rice crackers).
Homemade smoothies with yoghurt, chia seeds and fruit (e.g. 1 banana, 100g yoghurt, 100ml milk, 1 tbsp chia seeds and 1 handful blueberries).
1 serving Granola with 1 serving of Greek yoghurt.
1/2 avocado on 1 slice toast with a glass of fruit juice.
2 tbsp almond butter on 3 oatcakes with 1 banana sliced on top.
3 peanut butter cookies with a portion of fruit.
 
To read my healthy eating tips for Eating Disorders go here.

 

Ignore the Numbers and Ditch the Scales.

Weight. It’s a complex issue and I think we often oversimplify it. I can be guilty of this too. Working in weight management and eating disorders has shown me that the numbers on the scales do not always do what you expect them to do.

 You may be eating enough for weight gain and just not see it and vice versa for weight loss. I find it can be very confusing for people when they know they should have lost/gained weight and yet the scales say they have maintained. So let’s think it through.

  1. The body does not work in days or weeks like we do. I always advise people if they weigh themselves to stick to once a week on the same day at around the same time. It could be a couple of days later and you will get a different reading.
  2. Sometime there is a lag phase where your body takes a while to adjust and realise you’ve changed your dietary intake. 
  3. Weight is not just determined by what you eat. Your hormones, fluid intake and the time of the day can play a role too amongst other things. You will weigh more at the end of the day, when you have your monthly cycle and when you drink more.
  4. Muscle weighs more than fat, so if you are exercising more you may be building muscle and weigh more.

So let’s not focus on the individual numbers too much. Instead look at the trend over a few weigh-ins or if you are trying to lose weight why not think about ditching the scales and look at waist circumference measurements and how your clothes fit. I have one client who has to have her clothes taken in each time she visits the tailor which is a sure sign things are going the right way!

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Mealtime Guidelines for Eating Disorder Sufferers.

 When you have an eating disorder or disordered eating it can lead to mealtimes becoming a stressful, hated time. For parents, carers, loved ones and friends it can become an anxious minefield. With everyone treading on eggshells, what should be a relaxing eating experience turns into an emotional melting pot.

I’ve spent a number of years eating more meals than I can count with people suffering from all types of eating disorders. In that time I’ve worked with hundreds of clients and listened to their stories of meal times, spent time finding ways to make eating more bearable and sat with them practising it. I’ve had food thrown at me, been shouted at and watched all kinds of odd food behaviours. I’m no stranger to tears at the table, tantrums and food mysteriously disappearing. I’d pretty much say I’ve seen it all and this means I know how hard it is for the sufferer and for the carer too. So here are my top tips for sufferers on making mealtimes easier.

Planning and Preparation.

Plan out in advance what is going to be eaten, don’t get caught out by the element of surprise. If you are preparing the food yourself then keep it simple as the act of preparing the food can put you off eating it.

Distraction is your Friend.

Find some good ways of distracting your mind from your food.

  1. Have someone sit with you and talk to you, but set boundaries such as not talking about food, diets and body image. Having a list of topics to discuss can help the person sitting with you. Good topics include holiday destinations, movies, music, topical TV shows. If you get stuck have the paper to hand to get topics or even read a quotations book aloud.
  2. Have “feel good” music on in the background or the radio, but not the TV.
  3. Read a magazine/book.

Keep Calm and Carry On Eating.

Eat in a calm, quiet and comfortable atmosphere and place. Keep it as stress free as possible. As soon as you feel anxious your “fight or flight” pathway kicks in. Think about it. Your heart beats faster, you may feel hot and sweaty, you may feel shaky and clammy, your throat constricts, your appetite gets less – so it will definitely be harder to eat!

Portion Perfect.

Only put on your plate what you need to eat. Don’t overload it as it will seem overwhelming.

Meal Motivation.

Keep in mind the reasons why you need to eat these foods. Either think it through in your head or have a list of reasons written out to refer to at the table or just before your meal. Use your long term goals, physical health reasons or any others that are positive. 

Reflect.

After a meal reflect on what went well/not so well. If you struggled, think through how you could improve this for next time, what would help/did not help. There will always be highs and lows in recovery. That is normal, the trick is to not give up.

After Activity.

Have something planned to do afterwards to distract yourself and to help you relax. Listen to relaxing music, watch TV or phone a friend are all good options. 

If you need one to one support, an individual meal plan and more guidance on this, please get in touch. An eating disorder is a very difficult illness to live with, live through and for some to let go and live without BUT it CAN be beaten,

Healthy Eating for Anorexia Nervosa

I’ve worked in the field of eating disorders for about 10 years. It’s an area that both frustrates me and brings me to life. I find it challenging work, emotional at times and I have to constantly remember to celebrate every small thing. Yet I absolutely LOVE this work.

In a world where obesity is on the increase, healthy eating and low fat eating predominates. The Eat Well plate has been developed as a way to demonstrate healthy balanced eating. I use this visual guide as a talking point but with the emphasis that this is aimed at a healthy population trying to maintain weight or at overweight people trying to lose a little weight. Therefore the proportions may not be correct if you are trying to gain weight.

 

Here is my walk through the Eat Well Plate for Anorexia Nervosa:

 Fruit and Vegetables:

Most people with anorexia nervosa I come across have no problems in meeting the 5 a day target, in fact they can have the reverse issue and be eating too many portions!

  • These foods should make up about 1/3 of your plate at each meal and no more.
  • It’s important to eat a range of colours and types so you get the full range of nutrients.

Dietitian UK: Healthy Eating in Anorexia Nervosa, Fruit and Veg

 

Starchy Foods/Carbohydrates:

These foods are often thought to be the villains. Yes over-eating these will lead to weight gain, but not eating them will mean your body does not have enough energy. Carbohydrate foods (bread, rice, pasta, cereals, potatoes etc..) are the bodies preferred energy source so that means it will choose to burn them off as fuel over anything else.

  • Include them at every meal.
  • Go for wholemeal, whole grain versions where possible.
  • The more active you are the more you will need.

 

Dietitian UK: Healthy Eating for Anorexia Nervosa

Dairy Products:

Dairy foods are important as they provide the body with calcium, protein and in some cases Vitamin D. Super important for your bones. When you are a low weight and not eating enough the kidneys remove calcium from your bones to supply the body with needed calcium, leaving your bones weakened. This needs replacing!

 

  • Eat 3-4 portions per day (e.g. 1 glass milk, 1 small yoghurt, 30g cheese).
  • If you are weight gaining steer away from the low fat options, often these just have more sugar and additives in them anyway.
  • Think about the long term impact of having weak bones, it’s a great motivator.

 

Dietitian UK: Healthy Eating for Anorexia Nervosa

Meat, Fish and Other Proteins:

This includes eggs, tofu, soya, beans, pulses, lentils, nuts and seeds. Include these foods twice a day in your meal plan either as a main meal or a snack.

Dietitian UK: Healthy Eating for Anorexia Nervosa

 

Fats and Sugars:

These are included as part of healthy eating. Your body needs fat and sugar in order to function. There is a layer of fat around your internal organs acting as insulation and protection, there are essential fatty acids that your brain needs to function well and monounsaturated fats are good for your heart – so fat is not all bad.

 

  • Work up to including healthy fats in your diet – avocado, olives, oily fish, rapeseed oil, nuts and seeds.
  • Build in a challenge each week to eat a “scary” food.

Dietitian UK: Healthy Fats

What is Binge Eating?

This post was written for Slimsticks.

One of the words that commonly comes up when talking about diets and weight loss is Binge. For many this means a one off slip/lapse or an over-indulgence. For others it’s a recurring cycle that they hate but are stuck in….

A binge is defined by the American Psychiatric Assoication (1) as:

  1. Eating in a discrete period of time (e.g. 2 hours) an amount of food that is definitely large than most people would eat during a similar period of time and circumstances.
  2. A sense of lack of control during the epsiode of eating.

People describe being out of control and in another zone when bingeing, some people can’t actually remember a binge at all. Whereas other people plan a binge, buying the foods and working out when and where they can eat it. The majority of binges happen in secret and are not talked about. Binge foods are usually high sugar high calorie foods, high fat foods or carbohydrate rich foods, for example chocolate, biscuits, cakes, bread, cereal. However it can just be whatever is available.

The first moments of a binge bring pleasure and a sense of euphoria, but these feelings don’t last. People tend to eat rapidly during a binge, researchers have found women with bulimia are food twice as fast as women with no eating disorder (2).

The typical binge is 1,000-2,000kcal, but they can range up to 10-15,000. (3) To put this in context the average women should be looking to eat no more than 2,000kcals per day.

Binges where more normal amounts of food are eaten but the person still has all the feelings of being out of control are called Subjective Binges and binges where large amount of foods are consumed are known as Objective Binges.

What can trigger a Binge:

One of the keys to stopping binges is to work out what triggers them, here’s some of the common triggers:

  1. Feeling fat
  2. Gaining Weight “I’ve failed so may as well give up”
  3. Hunger and Dieting – The thought of food can become overwhelming.
  4. Breaking a Dietary Rule
  5. Having free time or a lack of routine.
  6. Boredom
  7. Premenstrual Tension
  8. Alcohol

I’ll be dealing with tips on how to break the binge cycle in the next blog post.

References:

  1. American Psychiatric Association. Diagnositc and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
  2. Effect of eating rate on binge size in Bulimia Nervosa. Kissileff H.R et al (2008). Physiology and Behavior 93 (3): 481-485.
  3. Overcoming Binge Eating. Dr Christopher G. Fairburn (1995). The Guildford Press

Do you think you have an Eating Disorder?

Are you worried you may have an eating disorder or do you have a loved one you are worried about? Read on for signs and advice on what to do next.

Eating disorders are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour.

They can affect all types of people at all stages of life and are more common than you think with 1 in 250 women and 1 in 2,000 men suffering from anorexia nervosa. Bulimia is 5 times more common than anorexia and 90% of sufferers are female. Binge eating usually occurs later in life affecting both men and women.

Eating disorders often occur out of the need for a person to feel in control of life or as a reaction to stress or a bad experience in life. They can be a way of coping with feelings that are making you unhappy or depressed. It may be difficult to face up to and talk about, feelings like anger, sadness, guilt, loss or fear.

Common Signs:

  •  Severe weight loss
  • Periods stopping
  • Feeling disastified with your weight and body shape
  • Having a fear of gaining weight
  • Becoming obsessed with calories adn what you eat
  • Thinking about food all the time
  • Feeling guilty after eating
  • Excessive exercising
  • Being sick after eating
  • being secretive about food and not wanting to eat with others.
  • Feeling out of control and eating large amounts of food in one go

If you feel you or a loved one may have an eating disorder the best place to go to get help is your GP, they can signpost you to your local eating disorder services and give you initial advice and support. It can be hard to admit you have a problem, but think about how much better life would be if you didn’t have to worry about your eating.

If you have a close friend you trust maybe try talking to them about how you feel, talking about it can be very therapeutic. Recovery is a step by step process that takes time and usually involves psychological help as well as input from a specialist dietitian with experience in eating disorders.

The Beat website www.b-eat.co.uk is also a great place to get good information.

This post is take from http://www.slimsticks.com/priya-tew-do-you-think-you-have-an-eating-disorder

A battle of the mind.

This week it’s Eating Disorders Awareness week (see the Beat website for more). A topic very close to my heart. I have worked in the field of eating disorders for about 7 years now.

 

Remembering back to my first few days in my NHS post I was pretty petrified! What was I going to say to someone who was refusing to eat? How could I help? How much of a challenge was this really going to be and was I up to it?

7 years on I’ve completely fallen in love with working in this field. It’s flipping hard work most of the time, but it’s so rewarding too.  I’ve met some amazing people who have shown such strength and grim determination. It hasn’t always been enough and it certainly hasn’t always been a happy place to be, but it is a job that makes me thankful for my life and my health almost everyday. Most of the people I’ve worked with have talked about a raging battle going on in their mind, to me that’s one of the key challenges – how to overcome this battle.

My approach to working in Eating Disorders has been to celebrate the small successes, however small. There have been moments when I have literally jumped up and down in excitement when a client has managed 1 mouthful of a slice of toast. In fact I feel like celebrating all over again now – WOOHOO! If that doesn’t make you excited then a career in Eating Disorders probably isn’t for you 😉 In my job I have to be empathetic, caring, patient, calm, focused and have attention to detail, but also direct, firm and in charge. To my clients I am the authority on nutrition and I have to show I know my stuff or they aren’t going to trust me. Fortunately for me, this has all come pretty naturally. I’m not sure my husband would say I’m a naturally patient person, but put me in front of a client with an Eating Disorder and suddenly I am.

Recovering from an Eating Disorder takes courage, tenacity and TIME. There is no quick fix. Living with someone who is recovering is amazingly hard too. If you know someone who is struggling then be patient with them and be kind. Try not to tell them they look like they have put on weight or that you’ve noticed they are eating more. Just support them quietly and gently, ask them if/how they need support. Give them time. It takes time to become ill so it will take time to get well also. Lastly remember that just because someone is a normal weight does not mean they are all better.